Hotel Marriot, Islamabad - January 17, 2018 MEETING REPORT. Organized by:

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1 4th National Steering and Coordination Committee Meeting On Civil Registration and Vital Statistics (CRVS) Hotel Marriot, Islamabad - January 17, 2018 MEETING REPORT Organized by: Technical Support Unit (TSU) Ministry of Planning, Development & Reform Government of Pakistan, Islamabad Supported by; UNICEF Pakistan

2 4TH NATIONAL STEERING AND COORDINATION COMMITTEE MEETING ON CRVS Islamabad - January 17, 2018 ABBREVIATIONS AJK Azad Jumu & Kashmir BHU Basic Health Unit CRMS Civil Registration Management System CRVS Civil Registration and Vital Statistics DBR Digital Birth Registration DG Director General DHS Director Health Services FATA Federally Administered Tribal Areas GB Gilgit Baltistan HR Human Resource HSS Health System Strengthening ICD International Classification of Diseases IOM International Organization for Migration IT Information Technology KPK Khyber Pakhtunkhwa LG&RD Local Government and Rural Development M/o NHSR&C Ministry of National Health Services, Regulations & Coordination, M/o PDR Ministry of Planning, Development and Reforms M/o SAFRON Ministry of States and Frontier Regions MNCH Maternal, newborn and child health MoU Memorandum of Understanding NADRA National Database & Registration Authority NIPS National Institute of Population Studies NSC National Steering Committee P&D Planning and Development PBS Pakistan Bureau of Statistics PSC Provincial Steering Committee PWD Population Welfare Departments RHC, Rural Health Center SSD Social Sector Development SDG Sustainable Development Goal TSU Technical Support Unit UC Union Council

3 MEETING REPORT Background Information: CRVS is the mechanism of collecting information by civil registration system on the frequency of occurrence of specified and defined vital events (e.g. births, deaths, cause of deaths, marriage, migration, its compiling, processing, analyzing, evaluating, presenting and disseminating these data in some statistical form. The significance of improvement of Civil Registration and Vital Statistics (CRVS) has recently been emphasized round the globe. CRVS data is critical to support the government functioning watch the development processes and for monitoring of essential Sustainable Development Goals (SDGs). Pakistan like several other countries of the region do not have credible registration of births and deaths, and lack in reporting complete and accurate cause of death data. Almost 230 million children, under the age of 5 years, are not registered world-wide which include 20 million in Pakistan. Unfortunately, information disaggregated by age, gender, location and/or socioeconomic status is also not available like for many developing nations. Pakistan has been identified as one of the six priority countries by UNESCAP, where the CRVS strengthening would be undertaken during coming years. The aim is to facilitate people of Pakistan in realization of their rights regarding health and development by registering them into the system until the end of year In this regard, there are following three major goals: 1. Universal civil registration of births, deaths and other vital events 2. All individuals are provided with legal documentation of civil registration of births, deaths and other vital events, as necessary, to claim identity, civil status and ensuing rights 3. Accurate, complete and timely vital statistics (including on causes of death) are produced based on registration records and are disseminated. Given the fact that the subject of CRVS is multidisciplinary in nature, the task of overall coordination for CRVS development at federal level, has been assigned to Ministry of Planning, Development and Reforms (MOPDR). This ministry has been pursuing this agenda since During 2014 MOPDR, in close coordination with Provincial Departments, NADRA, the WHO country and regional offices, Plan international, UNICEF and other partners organized Rapid and Comprehensive Assessments of the CRVS" in Pakistan mainly to realize the current status of CRVS implementation in Pakistan. As a multisectoral operation, well-functioning national CRVS systems involve a wide variety of government ministries and agencies at the national, provincial, and local levels. A national CRVS coordination mechanism that comprises all relevant stakeholders, such as the civil registration authorities, the health and education ministries, the statistics offices, provincial and local governments, civil society and possibly development partners is essential to facilitate coordination, coherence and harmonization to avoid duplication of activities. In light of this, MoPDR constituted a National CRVS Steering and Coordination Committee during July This committee is headed by Federal Minister MOPDR while membership drawn from multiple provincial departments and multiple stakeholders. In total three Steering Committee meetings has been organized so far. This 4 th National Steering and Coordination Committee Meeting is being organized as part of the the process.

4 Facilitation and Participation. This meeting was chaired by Dr. Asma Hyder, Member (Social Sector & Devolution), Planning Commission. Dr. Murtaza Haider, Assistant Chief M/o PDR was the overall moderator for the meeting. Following were the main presenters of meeting. Dr. S. M Mursalin, Technical Adviser, TSU-CRVS Mr. Aftab Khan, Director - CRMS NADRA Ms. Muqaddisa Mehreen, Child Protection Specialist UNICEF Mr. Zahid Jalbani & Mr. M. Shoaib, Plan International, Islamabad Participation was derived from Federal Ministry of Planning, Development and Reforms, Ministry of Health, Pakistan Bureau of Statistics, NADRA, Mo/Law & Justice, Provincial Departments of Planning and Development, Provincial Health Departments, Local Government Departments, Provincial Bureaus of Statistics, Local Government Departments representatives from international partner agencies. List of participants is annexed at B Proceedings of the Meeting. Meeting started with the recitation of Holy Quran by Mr. Tayyeb Nazeer. This was followed by a round of participant s introduction. Dr Mujtaba Haider, Assistant Chief M/O PDR moderated the proceedings of the meeting. Mr. Qamar Abbas, Chief Health and Population, M/o PDR welcomed the participants on behalf of M/o PDR stated the objectives of the meeting; To understand progress so far made for functioning of CRVS at various levels. To discuss multiple options for the issues and barriers being faced for CRVS implementation. To discuss roles and responsibilities for multiple CRVS players and timelines. To discuss way forward for CRVS promotion. Dr Asma Hyder, Member Social Sector & Devolution (Planning Commission) in her opening remarks deplored the dismal situation of civil registration and vital statistics in the country. She said a lot has been done to improve the CRVS situation but unfortunately all these efforts lacked cohesiveness and continuity. This effort was not adequately supported by a holistic vision and strategic planning process desired for such country wide initiatives. CRVS is crucial information needed for tracking the progress of the country specially for Sustainable Development Goals, to which Pakistan is a signatory. To meet this challenge Ministry has now formulated a National CRVS Steering Committee under the chairmanship of Federal Minister M/o PDR and also created Technical Support Unit for CRVS Promotion. It is hoped that similar arrangements would be made at provincial levels and progress would be made in a collaborate manner. She expressed her satisfaction over the large attendance and presence of all the provincial representatives and CRVS stakeholders. She hoped that this learnt group would provide some tangible solutions to the issues faced in CRVS- promotion.

5 Ms. Sara Coleman, Chief Child Protection Section- UNICEF, in her remarks expressed that UNICEF is excited to work with M/o PDR and the Provincial Governments on this important subject. UNICEF is already working on a birth registration improvement project titled Digital Birth Registration Project- DBR. For this it has also supported the development of fully furnished state of the art DBR- Project Coordinating Units within the Local Bodies Departments. Under its DBR project UNICEF is closely working with the Governments of Punjab and Sindh for the improvement of Birth Registration System (DBR). Districts of Thatta and Badin from Sindh and Bahawalnagar and Pakpattan form Punjab have been selected as pilot projects. NADRA is duly involved in these pilot projects. She told that promotion of CRVS has been recognized as one of the important areas of work in current UNICEF plan. Now UNICEF support is available for CRVS strengthening through its current work plan ( ). Through this new five-year plan UNICEF would not only focus on improving birth registration, but would also, be in position to support overall institutional development of CRVS in Pakistan. She emphasized that data and experience that emerged from DBR pilot project is a good value addition for the CRVS strengthening in the country. Dr. S. M. Mursalin, Technical Adviser, Technical Support Unit -CRVS provided an insight into Civil Registration & Vital Statistics (CRVS) and need for well-functioning CRVS in the country. He said that in principle there exist four critical steps for CRVS improvement. These include CRVS Situation Assessment, Strategic Planning, Operational Plans/ implementation and then Monitoring. He briefed the forum about the important activities/ steps initiated so far regarding CRVS strengthening. He said government is fully alive to its significance and relationship to planning and decision making process. CRVS improvement is well reflected under Pakistan Vision 2025 and national five year plans. He briefed about the salient features of CRVS Assessment conducted during He said that this assessment came up with serious system weaknesses and called for improvement of CRVS in the country. It recommended formulation of strong coordination mechanisms with all relevant ministries, departments and partners on board. Towards this end, National Steering Committee on CRVS came into existence in Similarly, TSU-CRVS Unit has accordingly been established to oversee and facilitate the CRVS development process. Three meetings of steering committee have so far been held and current one is the 4th one. He stressed the need for a uniform CRVS law replacing current piecemeal legislation. He also made conceptual presentation on features of a well-functioning national CRVS. He said that an efficient CRVS system is much desired to monitor progress of Sustainable Development Goals. Participants were also informed about the role and scope of Technical Support Unit-(TSU-CRVS) and its potential activities during

6 Ms. Muqaddisa Mehreen, UNICEF -DBR Project Lead, presented an overview of UNICEF supported Digital Birth Registration (DBR). She described that major impediment to Birth Registration primarily include registration cost, long distances, limited access to services and lack of awareness. She presented national statistics showing the birth registration rate for children <5 years is highest in Punjab (i.e.73 %). This is followed by 29 % in Sindh, 23 % in GB, and less than 10 % in KP and Baluchistan. FATA was presented with the lowest registration rate of 1% among others. The reason of low registration rate in FATA is due to the limited outreach and capacity of Local Government and Rural Development Department. She further informed that according to the national statistics, 5 million children are born every year in Pakistan. Till date, around 60 million of the total children, under the age of 5 years, are not registered with the increase of 1.6 million every year in this cohort. This daunting situation calls for much work on strengthening the CRVS system in the country. When dividing the regions with respect to rural and urban areas, 83% and 68% of the total children, under the age of 5 years, are unregistered respectively. The percentage of registered children in rich families is 91% which is significantly higher than the families with low income with 45%. Similarly, with respect to educated versus illiterate parents the ratio of registration is 91% and 59% respectively. Data was also presented for estimated number of un-registered births in target priority districts of Punjab and Sindh. Four major parts of DBR system include user management, district management, union council management, and access management. The DBR system has improved the technological literacy, stakeholders' coordination, real-time solution & monitoring and sustainability in the birth registration process. One of main challenge for CRVS programs is the adoption of new technology and implementation. This improvement to be coupled with availability of human and financial resources. She emphasized the importance of developing linkages and knowledge sharing among various sectors. This would help avoiding duplication and ensure judicial use of limited resources. Mr. Aftab Khan, Director, CRMS, NADRA- HQ Islamabad gave a comprehensive overview of Civil Registration Management System being executed by NADRA throughout the country. He said NADRA s aim is to capture information regarding vital statistics from general public through its units spread all over the country. During the process we ensure data quality and maintain National NADRA Data Base. This database intern helps in day to day citizen registration, certification and in multiple other functions. He explained about various NADRA initiatives to improve CRVS including new design of digitally secured paper for CRMS certificates, verification mechanism to check authenticity, development of online application, and expansion of CRMS operations to country level. These initiatives increase significant number of vital event registration in past 13 years. He also presented facts and figures on vital events registered (Birth, Deaths, marriage & Divorce) by his organization over the years of NADRA is coordinating with several other departments and stakeholders to perform its roles. He further explained that NADRA is fully committed to the cause of promotion of CRVS system and would continue coordinating for each national/provincial level effort.

7 At the end he gave a number of recommendations improve CVRS status. He stressed the need for greater harmony and coordination among various CRVS stakeholder to make this effort successful. Other recommendations included formulation of regulatory authority at federal level, capacity building, need for legal framework, up-gradation and linkage of health and education facilities. He also stressed upon importance of accelerated awareness campaigns to enhance registration of vital events. All these recommendations were later fully endorsed by the participants. Mr. Zahid Hussain Jalbani, Project Manager Plan International, provided an overview of Training Manual that Plan has developed on an Effective CRVS System in Pakistan. He briefly gave an overview and background of development of the manual and also highlighted some weaknesses of the CRVS System in Pakistan. He said it is pity that we have so low birth registration and death registration is almost nonexistent in the country. He underscored the importance of strengthened CRVS system to achieve universal coverage. He said legal identity is essential for a variety of services, social protection and human rights. He emphasized on the need of training of all concerned with articulation and implementation of the system for which the manual has been developed. In description of manual, he told that the training manual comprises nine modules and the participants will be trained through interactive teaching method and group exercises on CRVS. The handouts are developed and would be distributed to the participants as resource material. This also include local CRVS practices to be shared for better understanding. He also explained each module along with its contents and outcomes. In her closing remarks Dr Asma Hyder, Member (SS & D) Planning Commission appreciated the substance of the presentations made, the active participation of various departments and partners. She lauded their efforts in putting forth some concrete set of recommendations and the decisions for CRVS Strengthening in the country. She stressed the need for timely finalization and implementation of the action plan proposed by the participants for She hoped that TSU- would soon be fully furnished and becomes functional to take a lead and play its designated role. At the end she thanked all the participants for making this meeting a real success.

8 Discussion Points / Observations Mr. Safdar Raza of Plan International showed keen interest for the organization of CRVS training workshop especially for the policy makers / senior managers. For this he aspired to make use of CRVS Training Curricula recently developed by Plan International. Mr. Muqaddar Shah from UNFPA stressed the need for data quality improvement, analysis of the data being captured by NADRA from throughout the country. He recommended to promote a culture of development of National Annual CRVS Reports and its dissemination. UNFPA would be pleased to support such a move. Mr. Akram Ali Khawaja, Special Secretary Health Sindh showed keen interest for improvement of Birth and Death Registration in Sindh through government health facilities including primary care facilities (RHC, BHU, etc.), District Hospitals and Tertiary Hospitals. For this his department would welcome any guidelines or source mechanism suggested by TSU-CRVS or partner organizations. He also suggested that the recommendations already made by Director CRMS- NADRA and Technical Advisor CRVS M/0 PDR should be endorsed by the participants as recommendations and next steps. Dr Zulfiqar Khan, WHO CRVS Focal Person, said that his organization would be much pleased to work with TSU-CRVS for the improvement of death and cause of death registration including situation analysis, planning and capacity building. To a question raised about the functioning of NADRA in FATA region, it was informed by NADRA representative that a separate MoU has recently been singed between NADRA and FATA Secretariat for initiating CRMS / NADRA services. Dr. Sabeen Afzal M/o Health Services informed that National Health Insurance Program is rigorously implementing ICD codding for determination of death registration in its 40 pilot districts. Efforts should be make to use this information for planning and decision making. Ms. Sarah Coleman, Chief Child Program UNICEF informed the participants that UNICEF very much keen to replicate its Digital Birth Registration (DBR) Model in other districts and provinces, subject to demand and availability of resources. She agreed that UNICEF is trying to address the issue of sustainability of its DBR Project through capacity building and close coordination with its counterpart. Towards this UNICEF has established well equipped DBR Coordinated Units in local bodies department at both Punjab and Sindh Provinces, which are playing vital role in this connection. Mr. Tariq Mahmood, DG, KP Bureau of Statistics stressed the need for greater involvement of his office for CRVS Strengthening. Mr. Javed Anwar, Secretary Health Balochistan expressed his dissatisfaction on the current status of Birth and Death Registration in his province and assured all coordination and support of his department for CRVS promotion.

9 He also proposed that the overall goal of CRVS coordination at provincial level be assigned to Local Government Department and Provincial Broad based Steering Committee be formulated at the earliest. Mr. Zahid Jalbani of Plan International Suggested that a reasonable fund (approx. 30,000/month) be available at the Union council level to meet operational cost for CRVS office support and certification. Efforts be made by Provincial Authorities in coordination with development partners to improve Civil Registration Infrastructure both at supervisory and grass root level (Union Council). There should be provision of regular budget, IT equipment, HR and trainings. Mr. Ghulam Rasool, Director Gilgit Baltistan informed that his department has recently procured 600 desktops computers and printers for union councils of his region which are being installed in a phased manner. Mr. Mahmood Masood Tamana, DG Local Gov. Dept- Punjab informed that his department is striving hard to improve birth registration in his province. For this MoUs has been signed with NADRA and UNICEF. His department would be much pleased to take the challenge of implementing the CRVS program as a whole than in piecemeal manner. Recommendations/ Decisions. Given the time lag a fresh communication be sent to provinces on the formation of broad based Provincial Steering, Coordination and Implementation Committees with due representation from departments of: Planning And Development, Local Government Bodies, Health Department, Law Department, Department of IT, Department of Education, Bureau Of Statistics, Population Welfare Department, Home Department. Provincial NADRA Office, Municipal Cooperation/ Registration National Health Insurance, Provincial BISP Department, Tertiary Care Hospital Representation Health Care Commission. Provincial Law Committee (Prov. Assemblies), Partners (UNICEF, WHO, UNFPA, Plan Int. etc.) Decision regarding Provincial Secretariat of the committee is to be communicated by the office of the Chief Secretary. To start with resources for the initial round of Provincial Steering committee meetings be extended by TSU M/o PDR through UNICEF allocation during Composition of National Steering Committee be extended by adding representative from M/o SAFRON and International Organization for Migration (IOM).

10 To maintain continuity of CRVS development process concerned Ministries/Departments be asked to designate a regular CRVS focal person with no frequent changes, for the upcoming CRVS events. TSU-CRVS M/o PDR would coordinate with NADRA, PBS and NIPS to explore the possibilities of analysis of CRMS data from NADRA database to develop use able Vital Statistics and their dissemination to the line departments. Development of Annual CRVS Reports and CRVS-SDG Indicators Reports would also be looked into. TSU-CRVS M/o PDR need to liaise with CRVS Regional Partners (WHO, UNFPA, UNICEF) for international best practices and for technical coordination. Regulatory Authority/ Mechanism to be evolved at Federal level to create a strong link between Civil Registration Authority and Local Government departments. Model CRVS districts- aiming comprehensive registration for multiple vital statistics and use of data in decision making be created in coordination with international partners. Mechanism be evolved for establishing linkages with Health and Education Facilities for the enhancement of Vital Statistics registration. To generate demand there is greater need for sensitization of policy makers, district managers and key players. Similar awareness campaigns may also be launched for general public on the benefits of registration of births and deaths. As recommended in earlier steering committee meetings efforts be made for the development and enactment of uniform National CRVS Law ensuring reporting of vital events on occurrence. Government should plan creation of CRVS Coordinating Units/ Hub at the level of district / tehsil for extending one window CRVS Services to the general public. As an immediate short term measure ( ) TSU should plan: o o o o o Organization of Provincial Steering Committee Meetings/ Advocacy Seminars. In-depth Provincial CRVS Assessment Initiation of CRVS Legislative Reforms Development CRVS Annual Reports. Creation CRVS Model Districts. o National CRVS Strategic Planning Process during

11 Annex A 4th National Steering and Coordination Committee Meeting on CRVS Islamabad - January 17, 2018 Agenda Timings Title Facilitator/Presenter pm pm Registration of the Participants pm pm Recitation of the Holy Quran pm pm Introduction of Participants pm-03.15pm Welcome and Objectives Mr. Qamar Abbas, Chief, M/o PD&R pm pm Functioning CRVS and Way Forward. Dr. S M Mursalin, Technical Adviser TSU-CRVS pm pm Opening Remarks Chief Guest pm pm Tea/ Coffee Break Dr. Asma Hyder, Member (SS&D) pm pm Follow of decisions of earlier meetings of National Steering and Coordination Committee pm pm Discussion Dr. S. M. Mursalin pm pm Update of CRMS Programme NADRA Mr. Aftab Khan, Director - CRMS NADRA pm pm Discussion pm pm Implementation of Digital Birth Registration in Pilot Districts pm pm Discussion Ms. Muqaddisa Mehreen Child Protection Specialist UNICEF pm pm Initiatives of Plan International for CRVS strengthening Mr. Zahid Jalbani, Plan International, Islamabad pm pm Discussion pm pm Provincial/ Regional Level CRVS Status Representatives of Provincial/ Regional Governments pm pm Remarks of Development Partners pm pm Closing Remarks and Vote of Thanks Ms. Asma Hyder, Member (SS&D) onwards Dinner

12 4th National Steering and Coordination Committee Meeting on CRVS Islamabad - January 17, 2018 Annex - B List of Participants FEDERAL MINISTRIES / DEPARTMENTS S# Name Designation Department 1 Dr. Asma Hyder Member (SS&D) Planning Commission 2 Mr. Qamar Abbas Chief Population Section, M/o PDR 3 Dr. S. M. Mursalin Technical Advisor TSU-CRVS, M/o PDR 4 Mr. Muhammad Tayyab System Analyst TSU-CRVS, M/o PDR 5 Dr. Murtaza Haider Asssiatnt Chief Health M/o PDR 6 Dr. Sadaf Sardar National Program Officer Nutrition, M/o PDR 7 Dr. Bahrawar Jan Member National Accounts Pakistan Bureau of Statistics. 8 Dr. Nasser Mohiuddin Director Technical PPW, NHSR&C 9 Dr. Sabeen Afzal Deputy Director Program M/o NHSR&C 10 Mr. M. Moazzam Warraich Assistant Director Mo/Law & Justice 11 Mr. Shams bin Niaz Director, CRMS NADRA, M/o Interior 12 Mr. Aftab Saleem Dy. Director, CRMS NADRA, M/o Interior 13 Mr. Mohib ullah Add. Director, CRMS NADRA, M/o Interior PROVINCIAL DEPARTMENTS Punjab: 14 Mr. Mahmood Masood Tamana Director General (I&M) Local Gov. Dept. Lahore 15 Dr. Shafqat Sheikh Advisor PHC Punjab Health Care Commission 16 Mr. Saadat Ali Planning officer P & D Department. Lahore Khyber Pakhtunkhwa 17 Mr. M. Abid ullah Wazir Chief Economist P&D Dept. KPK 18 Mr. Muhammad Fakhir Alam Additional Secretary L.G. Department, KPK 19 Mr. Tariq Mahmood Director General Bureau of Statistics KPK Sindh 20 Mr. Akram Ali Khawaja Special Secretary Health Dept. Sindh 21 Dr. Nasim ul Ghani Sahito Director General Bureau of Statistics, Sindh 22 Mr. Muhammad Aeem Assistant Director (MIS) L.G. Dept. Sindh Balochistan 23 Mr. Javed Anwar Secretary Health Dept. Quetta 24 Mr. Abdul Ghaffar Kakar Director General Bureau of Statistical, Quetta 25 Mr. Rehan Najam Town Planner L.G. & R.D. Dept. Quetta

13 FATA 4th National Steering and Coordination Committee Meeting on CRVS Islamabad - January 17, 2018 List of Participants S# Name Designation Department 26 Mr. Javed Ullah Director DLG FATA Sectt. 27 Dr. Anisa Afridi MNCH Coordinator DHS, FATA AJK / GB 28 Khawaja Muhammad Masood Chief Planning LG&RDD. AJK 29 Mr. Muhammad Shamoon Hashmi Chief Economist P&D Dept. AJK 30 Mr. Jamil Ahmed Khan Chief Statistics P&D Dept. AJK 31 Dr. Masood Ahmad Buhkhari Add. DHS DoH, AJK 32 Dr. Syed Ghulam Haider Kazmi Consultant PIDD, AJk 33 Mr. Babar Aman Babar ACS/Secretary P&D Dept. GB 34 Mr. Ali Jabbar Deputy Chief (Health) P&D, DoH. GB 35 Mr. Ghulam Rasool Director /DC M&E P&D Dept. GB International Development Partners 36 Ms. Sarah Coleman Chief Child Program UNICEF Pakistan 37 Ms. Muqadisa Mehreen Child Program Specialist UNICEF PCO Pakistan 38 Mr. S. Asghar Ali SPA UNICEF Pakistan 39 Mr. Imran Y. Shami A. Country Director Plan International Pakistan 40 MR. Zahid Jalbani Project Manager Plan International Pakistan 41 Mr. Safdar Raza Advisor Manager Plan International Pakistan 42 Mr. M. Shoaib COMBI Coordinator Plan International Pakistan 43 Ms. Umera Javed Advocacy Officer Plan International Pakistan 44 Mr. Muqaddar Shah Prog/Tech. Analyst UNFPA Pakistan 45 Mr. Nasir Sarfraz Health Advisor DFID Pakistan 46 Dr. Nadeem Hassan Program Officer NMFC JSI.IHSS-SD /USAID - Pakistan 47 Dr. Zulfiqar Khan National Program Officer HSS WHO- Pakistan 48 Ms. Ruby Rehman Assistant Protection Officer UNHCR.